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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005468
Report Date: 11/09/2022
Date Signed: 11/15/2022 11:47:33 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2022 and conducted by Evaluator Todd Tryon
COMPLAINT CONTROL NUMBER: 25-AS-20221103141901
FACILITY NAME:BROOKDALE AUBURNFACILITY NUMBER:
317005468
ADMINISTRATOR:MORGAN WHINERYFACILITY TYPE:
740
ADDRESS:11550 EDUCATION STTELEPHONE:
(530) 888-8847
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:110CENSUS: DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Morgan Whinery, Executive Director TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff forced resident to take medication that was not hers
INVESTIGATION FINDINGS:
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On 11/9-2022 LPA Tryon visited the facility to open the complaint. LPA met with ED Morgan Whinery. LPA was screened at the door for COVID symptoms.
LPA inteviewed Mrs. Whinery regarding the allegations.
Regarding staff "forcing" resident to take medications that we not hers, LPA learned that recently a box of medication was dropped off with a Med Tech at the facility by a family member. A room number of the resident was written on the box. The box was in the med room for several days, then the facility contacted the doctor for the resident in the room written on the box and said a prescription was needed. The doctor agreed and wrote a new prescription for the resident IN THE ROOM listed. The medication was taken by a med tech to that resident, med tech showed the prescription to the resident, and resident took the medication. Resident later contacted family, who contacted the facility. In investigating the situation, the facility found out that the medication was actually brought by a family member of a resident with a similar room number for THAT resident. Therefore, even though the doctor did write up a prescription for the person who is the subject of this allegation, it was not truly meant for that person, but another. Therefore, the
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 25-AS-20221103141901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
VISIT DATE: 11/09/2022
NARRATIVE
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facility did give it to the wrong person. Allegation is SUBSTANTIATED. A finding that an allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

The following deficiency is being issued as per Title 22 Regulations. Appeal rights provided, exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 25-AS-20221103141901
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2022
Section Cited
CCR
87465(a)(4)
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The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidenced by: Through interivew of ED, LPA learned that the facility did in fact erroniously give resident R1 a medication intended for another resident
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The facility will ensure that residents only receive medications intended for that resident. The Administrator will come up with a plan to safely check in medications brought to the facility by responsible parties, etc. to ensure accuracy of information. Plan due to CCL by 11/10/2022.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2022 and conducted by Evaluator Todd Tryon
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20221103141901

FACILITY NAME:BROOKDALE AUBURNFACILITY NUMBER:
317005468
ADMINISTRATOR:MORGAN WHINERYFACILITY TYPE:
740
ADDRESS:11550 EDUCATION STTELEPHONE:
(530) 888-8847
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:110CENSUS: DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Morgan Whinery, Executive Director TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not safeguard residents personal belongings.
Staff did not ensure resident had a shower curtain.
INVESTIGATION FINDINGS:
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LPA spoke with witness and with facility ED regarding safeguarding personal belongings. The allegation refers to a check given to the facility by a resident/representative for initial payment. LPA learned that a check was given to the facility to set up automatic payments. Allegedly the check was reported to the resident as missing; but then was located in the resident's placement file. Therefore, the check was never really missing or stolen, but simply briefly misplaced. LPA cannot find that this actually is a violation of regulation in any way. Therefore, the allegation is UNFOUNDED.
Regarding staff not ensuring the resident had a shower curtain, through interview of witness and ED, LPA learned that the faciltiy generally does not provide shower curtains for new residents, but rather they provide it themselves. There may have been some misunderstanding regarding this between staff and resident/famil; and the family did provide the curtain themselves. LPA cannot find that this is in fact a violation of a regulation, therefore the allegation is UNFOUNDED. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4